PHA-Exchange> AIDS in Africa: The Devil is in the Details

[Stephen Minkin]

Please post this article written for my local US
newspaper for World AIDS Day. It raises two essential
points:

1. We can no longer ignore the risks of HIV
transmission in clinical settings

2. Multinational companies need to pay their fair
share of the costs required to ensure access to safe
health care


Many thanks for sharing this.

Steve Minkin

AIDS in Africa: The Devil is in the Details


By Stephen F Minkin
 

Perhaps you heard the public radio story about the
South African religious choir composed of people
infected by HIV. The group is currently touring the
United States. The obvious character and intelligence
of the singers complemented their beautiful music.
They spoke about their lives of faith while living
with this deadly infection.

“I wasn’t doing anything wrong”, commented one woman
in all sincerity. “ I wasn’t fooling around, It must
have been God’s plan for me. “ 
 
There is much more to AIDS in Africa then “fooling
around”.  Maybe it is the devil who resides in the
double standards of AIDS prevention when applied to
rich and poor countries.

 Nigerian novelist Chinua Achebe’s observations about
Dr Albert Schweitzer address the heart of the problem:

 “Schweitzer says,  `The African is indeed my brother,
but my junior brother.’ And so he proceeded to build a
hospital reminiscent of the needs of junior brothers
with standards of hygiene reminiscent of medical
practice in the days before the germ theory of disease
came into being.”


Today, Africans are still seen as junior brothers and
sisters for whom the germ theory of disease only
applies to their sexual organs.

Imagine AIDS in the United States if we only
highlighted condoms and sex education but were
haphazard in the application of universal precautions
and blood screening. Suppose our doctors and nurses,
faced with large numbers of sick people, were unable
to use sterile equipment for every procedure. If they
reused syringes, needles, catheters, and specula
without adequate infection control. Under these
circumstances, we too would have a crisis of women and
children dying from AIDS. 

Surely, HIV is sexually transmitted in Africa, but, as
in the United States and Europe, there is much more to
the story than sex alone. The incidence of blood-
borne HIV is greater in countries where women start
childbirth early and have closely spaced pregnancies.
Obstetric emergencies and pregnancy-related anemias
are vexing problems in African countries where the
prevalence of HIV among potential blood donors makes
safe blood a scarce commodity.


UNAIDS estimates that 5-10 percent of global HIV
infection burden is directly related to blood. This
translates to millions of people dying from AIDS. 
Added to these grim statistics is the unsolved problem
of dangerous injections. The October 1999 issue of the
World Health Organization Bulletin reported that over
50 percent of injections were unsafe in African
countries for which data was available. 


Here is part of a message I received  from a friend
working in Uganda:

"The one unfinished research item on the HIV
transmission occurs in places
such as Mulago Hospital where 70 deliveries are done
daily, sometimes without
access to running water and without rubber gloves for
the midwives. Mulago is the best and then when you
think of rural hospitals and how much blood is
associated with deliveries and what proportion of the
women are
HIV positive..."


Investing in AIDS prevention without focusing on
problems like these is like pouring water in a
bottomless bucket. Without safe health care, much of
the future spending on AIDS will be both ethically
dubious and ineffective.

Such issues have not been popular within the
international AIDS community. I personally do not
understand the global double standard.  Are black
people less vulnerable than white people to the
dangers of HIV contaminated blood and medical
procedures? 

When I read in newspapers that billions of dollars are
needed to fight AIDS, I applauded. But then I asked, "
how will the money be spent"?  What proportion will
actually go to improving the quality of healthcare
where it is needed and what will be spent in Europe
and the United States in the name of fighting AIDS.

We should not forget that HIV is a sexually
transmitted disease and in this respect women are the
ones most vulnerable. But HIV is much more than a
sexually transmitted disease. Again it is women who
are exposed to the greatest risks of medically
transmitted infections. Of the billions of dollars
required to fight AIDS,  a large chunk must go to
providing resources to ensure safe, quality
healthcare.
 





For centuries the West has exploited Africa's human
and natural resources. Europe and the United States
have most often been behind the violence and war that
have plagued and ruined much of the continent. It is
now time to make things right. One important step is
to ensure that no woman, man or child is infected by
HIV when seeking health care.  It is also time for
multinational companies that profit from Africa’s
wealth to pay a fare share of the costs for  the
treatment and prevention of AIDS.

-30-


Word count : 771 words

Stephen F. Minkin, is a coordinator of the Network for
Infection Prevention (NIP) www.Africa-hiv.org  and is
the Cancer Registrar at Brattleboro Memorial Hospital.


=====
Steve Minkin
PO Box 6073,
Brattleboro, VT 05302

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